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Health Advisory: Hepatitis A Outbreak in San Diego and Santa Cruz Counties

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Health Advisory

 

June 28, 2017

 

From: Edward L. Moreno, MD, MPH                                       Kristy Michie, MS

             Health Officer    831-755-4585                                   Epidemiologist  831-755-4503


Hepatitis A Outbreak in San Diego and Santa Cruz Counties

 

Medical providers are urged to vaccinate susceptible individuals who may be homeless, incarcerated, or use drugs illegally, as well as others at risk for infection.

Current Situation

The San Diego County Health and Human Services Agency reports an ongoing outbreak of hepatitis A virus (HAV) infections.  As of mid-June, over 160 cases have been reported to San Diego County Health Officials.  Four deaths have been attributed to the outbreak.  Many cases, but not all, have been associated with homelessness, incarceration, or illicit drug use. To date, no common food, drink, or drug source has been identified.  Santa Cruz County is also experiencing an outbreak of HAV.  Since April, the Santa Cruz County Health Services Agency reports that 20 individuals have confirmed HAV infections.  These cases share one or more of the following characteristics: illicit drug use (injection and non-injection), homelessness, and/or dense living conditions.  To date, there have been 2 reported cases of HAV infection among Monterey County residents, which is similar to morbidity patterns in previous years. 


Recommendations

  • Screen individuals for HAV who present with clinically compatible illness. 
    • Order IgM antibody tests for HAV (IgM anti-HAV).
    • Total anti-HAV alone cannot distinguish between current disease, past disease, and vaccination-induced immunity.
    • IgM anti-HAV testing should be limited to individuals with evidence of clinical hepatitis.  It should not be used as a screening tool for asymptomatic patients or for patients without clinically compatible illness. 
  • Report suspected cases promptly to the Health Department (phone: 831-755-4521; fax: 831-754-6682; after hours call 831-755-5100 and ask for the on-call Health Officer).  Early reporting leads to prompt preventative interventions among close contacts and limits the spread of disease.
  • Promote vaccination among your patients.  Vaccination now can prevent an outbreak in Monterey County.  People who should be routinely immunized with HAV vaccine include: 
    • All children between their first and second birthdays (12 through 23 months of age).
    • Anyone 1 year of age and older traveling to or working in countries with high or intermediate prevalence of hepatitis A, such as those located in Central or South America, Mexico, Asia (except Japan), Africa, and eastern Europe.
    • Men who have sex with men.
    • People who use drugs illegally.
    • People with chronic liver disease.

Individuals who work closely with homeless people and illicit drug users on a frequent and ongoing basis, such as those who work or volunteer at homeless services agencies, may consider HAV immunizations at this time if they are not already vaccinated.  The Monterey County Health Department also encourages vaccination of incarcerated individuals.

If you have additional questions or concerns, please call the Monterey County Health Department’s Communicable Disease Unit at 831-755-4521, visit our website at http://www.co.monterey.ca.us/government/departments-a-h/health/diseases/hepatitis-a, or refer to the Centers for Disease Control and Prevention’s (CDC’s) hepatitis A website: https://www.cdc.gov/hepatitis/hav/index.htm.


Health Alert: Warrants immediate action or attention
Health Advisory: Provides information for a specific incident of situation; may not require immediate action.
Health Update: Proves updated information regarding an incidient or situation; unlikely to require immediate action.

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